Academic journal article Journal of Nursing Scholarship

Typologies of Professional Identity among Graduating Baccalaureate-Prepared Nurses

Academic journal article Journal of Nursing Scholarship

Typologies of Professional Identity among Graduating Baccalaureate-Prepared Nurses

Article excerpt

A nurse's professional identity is thought to create the foundation for promoting the ideals of the profession and thus serves as a key factor in providing quality care that improves patient outcomes (Benner, Sutphen, Leonard, & Day, 2010; National League for Nursing, 2010). Though few dispute the importance of such an identity, what constitutes this phenomenon and how it is constructed is poorly understood (Johnson, Cowin, Wilson, & Young, 2012).

Literature Review and Theoretical Background

Professional Identity and Quality and Safety Education for Nurses

Ensuring safe care is a fundamental value and ethical responsibility of the nursing profession (International Council of Nurses, 2000). Growing recognition that adverse events are a significant cause of morbidity and mortality has given rise to global efforts to improve patient safety (Donaldson & Fletcher 2006; Institute of Medicine [IOM], 1999; Richardson & Storr, 2010). Within the United States, the Quality and Safety Education for Nurses (QSEN) project represents a national effort to redesign nursing education around knowledge, skills, and attitudes increasingly necessary to protect patient safety and improve care (Cronenwett et al., 2007). Developed with funding from the Robert Wood Johnson Foundation and building on the IOM (2003) report that found clinical education had not kept up with changing healthcare systems and patient populations, QSEN created a new paradigm for nursing education. In order to practice safely and effectively, QSEN posits that the foundations of a nurse's professional identity should be grounded in six competency areas: (a) quality improvement (QI); (b) safety; (c) patient-centered care; (d) informatics; (e) evidence-based practice (EBP); and (f) teamwork and collaboration.

Though experts suggest that QSEN should serve as the foundation of a nurse's professional identity and employers are beginning to look for the QSEN competencies in new hires (Falls & Hensel, 2012), very little is known about if or how the QSEN attitudes are collectively internalized to form this identity. Individual characteristics may play a role in how students integrate these attitudes. Types of programs and educational experiences, such as clinical placement in community versus academic institutions, may influence students' knowledge, skills, and attitudes (Sullivan, Hirst, & Cronenwett, 2009); having children or being a caregiver has been associated with more positive patient-centered attitudes (Johnson & Lindschau, 1996); and ethnicity and gender have been found to factor into professional values (Lou, Li, Yu, & Chen, 2011; Wros, Doutrich, & Ruiz, 2009).

Several studies have addressed the acquisition of competency domains individually. However, a Web of Knowledge literature search using "QSEN" as the key word yielded only five studies with outcomes in all six competencies areas (Chenot & Daniel, 2010; Dycus & McKeon, 2009; McKown, McKeon, & Webb, 2011; Riley & Yearwood, 2012; Sullivan et al., 2009), and these studies provided a very limited understanding of how strongly students internalize the various QSEN attitudes.


Self-perceptions that arise from attributes, beliefs, values, motives, and experiences create an individual's professional identity (Slay & Smith, 2011). First described by Stephenson (1935), Q-methodology offers a unique way to study such perceptions. This mixed-method approach to factor analysis uses statistical principles to objectively study subjective attitudes, opinions, and beliefs (Brown 1980, 1993). Whereas traditional research methods correlate participants' responses to research variables, Q-methodology correlates participant response profiles to each other. Through the process of rank-ordering agreement or disagreement with a set of subjective statements on a given topic, statistical principles can be applied to discover natural groupings of attitudes (Van Exel & de Graaf, 2005). …

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